Provider Demographics
NPI:1104260355
Name:KINOSHITA, SHIORI (NP)
Entity type:Individual
Prefix:
First Name:SHIORI
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5354
Mailing Address - Country:US
Mailing Address - Phone:646-549-6520
Mailing Address - Fax:
Practice Address - Street 1:234 E 85TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3001
Practice Address - Country:US
Practice Address - Phone:212-241-6585
Practice Address - Fax:212-731-3391
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340869363LG0600X
NYF306268363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology